Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4417 | TX |
NPI | 1639297310 |
---|---|
Provider Name | Dr. Dennis John Cannon |
First Address | Flower Mound, TX 75027-1209 |
Second Address | Flower Mound, TX 75028-2714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |